Bhutani's nomogram
Vinod Bhutani is an American Professor of paediatrics who devised the hour specific bilirubin nomogram below as a way of trying to predict in the first few hours of life which babies are most at risk of getting severe hyperbilirubinaemia. It has been adopted by the American Academy of Paediatrics as a tool to aid safe early discharge home of newborns. It is not to be used blindly – he excluded from the study babies who had required 1st day phototherapy, sick babies and those with ABO sensitisation. It also should only be used for babies of more than 36 completed weeks gestation with a birth weight of at least 2000g.
The lines on the nomogram are centiles, not treatment lines as on our phototherapy charts. In his study, 62% of the babies fell into the low risk zone (below the 40th centile line) and none of them went on to develop severe hyperbilirubinaemia. Only 6% of his babies were in the high risk zone (above the 95th centile) and only 40% of these continued in this zone and required treatment (he waited for 2 readings in the high risk zone before starting phototherapy). 13% of the high intermediate risk zone babies moved up to the high risk zone and 2% from the low intermediate risk zone moved up to high risk.
The nomogram is a very useful tool to guide decision making in babies being discharged early from the postnatal wards.
